Part B Insider (Multispecialty) Coding Alert

Published on Sun Oct 10, 2010 PDF

Unfortunately, RNs don't make the cut under CPT's new definition.

Wondering just who is eligible to administer that vaccination, prolonged service, or neuropsychological testing? If your MAC follows CPT rules, you can exclude registered nurses from that list.

At the request of many physicians, CPT 2012 now defines the term "other qualified healthcare professional." Although this definition didn't make it into the 2012 manual, the AMA lists it as part of the "CPT 2012 Errata" on its Web site (www.ama-assn.org/resources/doc/cpt/cpt-2011-corrections.pdf) and the definition is as follows:

"A 'physician or other qualified health care professional' is an individual who by education, training, licensure/regulation, and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports a professional service. These professionals are distinct from 'clinical staff.' A clinical staff member is a person who works under the supervision of a physician or other qualified health care professional and who is allowed by law, regulation and facility policy to perform or assist in the performance of a specified professional service. Other policies may also affect who may report specified services."

Part B practices may be disappointed that RNs and LPNs aren't included in the definition, because it means that CPT will now preclude RNs and LPNs from reporting certain codes that are meant for physicians and "other qualified healthcare professionals" -- for instance, immunization administration codes 90460-90461, neuropsychological testing code 96120, cognitive testing code 96125, and prolonged E/M codes 99358-99359.

If your payer does not follow CPT rules on this issue, you may still be able to allow an RN or LPN to perform the service, depending on what your insurer states in writing. And remember that state and local laws may specifically dictate who can perform each type of service, so look to your state medical society for information on that as well.